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Coccidioidomycosis
Published in Rebecca A. Cox, Immunology of the Fungal Diseases, 2020
Skin-test reactivity to CDN is generally evident in 80% or more of persons who develop solitary pulmonary lesions, whereas one third or less of patients with progressive or chronic pulmonary disease manifest cutaneous delayed-type hypersensitivity (DTH) to CDN 1: 100.49,189–200 A similar relationship is observed between CDN skin-test reactivity and disease involvement in extrapulmonary coccidioidomycosis. Approximately 70% of patients with unifocal, extrapulmonary disease manifest reactivity to CDN 1:100, whereas less than 30% of patients with multifocal disseminated coccidioidomycosis respond to CDN or spherulin.49,50,60,195–200 Depressed or nondemonstrable cutaneous sensitivity to CDN denotes a poor prognosis for recovery. In a study of 100 patients with disseminated coccidioidomycosis, Smith et al.49 reported that 75% of the patients who were skin-test reactive to CDN 1:100 recovered from their disease as compared to only 17% of patients who were skin-test negative. Likewise, less than 10% of patients who failed to respond to the 1:10 dilution of CDN survived their disease.
Coccidioides
Published in Rossana de Aguiar Cordeiro, Pocket Guide to Mycological Diagnosis, 2019
Disseminated coccidioidomycosis may be present in 1%–5% of individuals infected with Coccidioides spp., despite the absence of clinical or radiological signs of pulmonary involvement (Cox and Magee, 2004; Crum et al., 2004). The disseminated form most commonly affects immunosuppressed adult individuals, such as patients with AIDS or lymphomas, or transplanted patients (Galgiani et al., 2005). Fungal dissemination occurs by hematogenous and/or lymphatic pathways, and can reach several organs, such as skin, central nervous system, lymph nodes, bones, joints, and urogenital system. Disseminated coccidioidomycosis has a high mortality rate (Galgiani et al., 2005), so it requires accurate diagnosis and treatment. In Brazil, the Ministry of Health recommends differential diagnosis with visceral leishmaniasis (kalazar), especially in areas of occurrence of both diseases.
Infections and infestations affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Six skin patterns are observed in disseminated coccidioidomycosis.274Pseudoepitheliomatous hyperplasia with a dense neutrophilic infiltrate, abscess formation, epithelioid cells, some eosinophils, and masses of spherules. The vessels have enlarged endothelial cells and dense perivascular infiltrates.Pseudoepitheliomatous hyperplasia with ulceration and initial infiltration with lymphocytes and plasma cells in the superficial and mid-dermis with gradual transition to an epithelioid and multinucleated giant cell rich infiltrate with abundant spherules.Ulceration with suppurative granulomas formed of histiocytes and giant cells, neutrophil abscesses with eosinophils, and a few spherules.This may become necrotic and show large areas of caseation.Intense eosinophilia with small granulomas.Sarcoidal reaction with large masses of epithelioid cells mainly in the mid-dermis and surrounding fibrosis.
Disseminated coccidioidomycosis in a patient on mycophenolate
Published in Baylor University Medical Center Proceedings, 2023
Chase Griffin, Christopher J. Peterson, Kanak Parmar, Jacob Nichols
To our knowledge, this case is the only report of severe disseminated coccidioidomycosis in a patient with polymyositis receiving MMF.3 MMF is a steroid-sparing treatment, with side effects of myelosuppression, hypertension, and tremors. It works by inhibiting de novo purine synthesis but has a delayed onset of activity for up to 3 months.5 Reports on fungal illness in patients receiving MMF are rare. We note a case of a 70-year-old man taking MMF and tacrolimus for a kidney transplant 2 years before developing Coccidioides pneumonia.6 As in our case, a combination of MMF with other immunosuppressive medication makes it difficult to determine the impact of MMF alone. Most cases of coccidioidomycosis in patients on immunosuppressive therapy involve patients on tumor necrosis factor alpha blockade.7 Immunosuppressive therapy may increase rates of fungal infection, specifically coccidioidomycosis.8,9
The molecular immunology of human susceptibility to fungal diseases: lessons from single gene defects of immunity
Published in Expert Review of Clinical Immunology, 2019
Candidiasis was not the only mycosis undergoing genetic dissection. Epidemiologic studies from Kern County, California, in the 1930s, had identified that ‘dark-skinned’ races (i.e. those of Filipino, Hispanic and African-American descent) were 10 to 175 times more likely to develop disseminated coccidioidomycosis relative to Caucasian counterparts living in the same area [39]. Further investigations in the 1970s identified blood group phenotype (and presumably genotype) and histocompatibility antigen (e.g. HLA-A9) as being disproportionately increased in frequency in those with disseminated disease [40]. Whether these antigenic variants are directly involved mechanistically in disease pathogenesis, or whether they reflect the particular demographics of those at-risk, is unclear. Nonetheless, these studies collectively identify that, in both penetrant or complex fashion, natural susceptibility to certain fungal diseases is genetically mediated.
Evaluation of laboratory diagnostic approaches for tuberculous pleurisy
Published in Infectious Diseases, 2019
Xiao-Chun Shi, Yu-Ting Tan, Li-Fan Zhang, Yue-Qiu Zhang, Xiao-Qing Liu
Tuberculous pleurisy was excluded in 180 patients, among whom the diagnoses included solid malignancies (76 cases), para-pneumonic pleural effusion/empyema (38 cases), heart failure/constrictive pericarditis (26 cases), connective tissue disease (12 cases), renal inadequacy (7 cases), hypoproteinemia (6 cases), portal hypertension (4 cases), polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome (3 cases), pneumoconiosis (3 cases), lymphangiopathies such as congenital dysplasia of the lymphatic vessels (2 cases), chronic active Epstein–Barr (EB) virus infection (2 cases) and disseminated coccidioidomycosis (1 case).